Pregnancy Information
Working in partnership with you
Page Section
3 What we offer - Maternity Services in Shropshire
9 Neonatal Services
10 Your pregnancy at a glance 11 Antenatal care 13 Keeping you and your baby healthy
16 Keeping you and your baby safe
21 Minor problems of pregnancy
23 Infections in pregnancy
26 Ultrasound screening 28 Pregnancy complications
32 Feeding and nurturing your baby
33 Information for partners
34 Getting ready for birth 36 Signs of labour
37 Induction of labour 39 Labour and birth 43 Pain relief
47 Assisted birth (operative vaginal delivery)
49 Caesarean section
53 Vitamin K
56 Rights and benefits
56 Trust Privacy Notice
59 Useful organisations
2 Pregnancy Information What we offer - Maternity Services in Shropshire Congratulations on your pregnancy! Every year around 5000 women give birth in Shropshire. We offer a caring and safe service, with a choice of where to have your care and where to have your baby. We have Community Midwives at Centres all around the county, at Shrewsbury, Telford, Bridgnorth, Ludlow, Oswestry, Whitchurch and Market Drayton. All of these Centres offer antenatal and postnatal care. If you have a straightforward pregnancy you can have your baby in a Midwife Led Unit (at Shrewsbury, Telford, Bridgnorth, Ludlow or Oswestry). You also have the choice of giving birth at home, or in the Consultant Led Unit at the Shropshire Women and Children’s Centre at the Princess Royal Hospital at Telford, although this Unit is primarily for women with more complicated pregnancies. For more information on these options please read the information below. Our Midwife-led Units (MLUs) Having a baby is one of the most important events in your Bridgnorth Midwife Led Unit life. The five Shropshire Midwife Led Units (MLUs) are able Tel:01746 711060 to offer you a place where you can feel comfortable, relaxed, confident and secure. You can contact the midwives at your local unit for advice and support during your pregnancy, when your labour is starting, and after you have your baby. It is also convenient for your friends and family to visit you when you’ve had your baby. Four of our MLUs are freestanding, which means they are on a separate site from the nearest main hospital. Wrekin MLU is on the same site (Princess Royal Hospital, Telford) as the Consultant Led Delivery Suite. In MLUs experienced midwives take responsibility for your care during labour and support you to have a normal birth. The Birthplace Study published in 2011 found that a planned Bridgnorth is a stand-alone MLU in Bridgnorth birth in an MLU was just as safe as having a baby in an obstetric Hospital. There is a birthing suite with a pool and a (doctor led) unit. This was true for women having a first baby second birthing room. There are birthing balls, bean as well as for those who had had a baby before. bags and mats available to help women stay active and comfortable in labour. Women who give birth on an MLU have less intervention After birth you can stay in one of the two postnatal in their labour and tend to report greater satisfaction with their birth. rooms, each with two beds and a TV, when staff can support you in feeding and caring for your baby.
Pregnancy Information 3
Ludlow Midwife Led Unit Oswestry Midwife Led Unit Tel: 01584 871120 Tel: 01691 404579 Ludlow is a stand-alone MLU at Ludlow Community The stand alone Oswestry MLU at the Robert Jones and Hospital. There is a relaxed, friendly and homely Agnes Hunt Hospital, has two calm and relaxing birthing atmosphere at this Unit. The staff aim to help you rooms, one with a large birthing pool. Postnatal care is and your family experience the best possible start to in a 6 bedded area where you can forge friendships in a parenting. caring environment. Shrewsbury Midwife Led UnitWrekin Midwife Led Unit Tel: 01743 261216 Tel: 01952 641222 ext. 5706 The Shrewsbury MLU is a stand alone unit in the Wrekin MLU is at the Princess Royal Hospital in Telford Copthorne Building at the Royal Shrewsbury Hospital. on the same site as the Consultant Led Unit. There are The unit has recently been refurbished, with a new birth four homely birthing rooms, one with a water pool. pool. CD players, birth balls, bean bag and mats are After the birth staff will help you with the transition available, as active birthing is encouraged. into motherhood in a quiet and friendly environment. After birth you will stay in a four-bedded bay, or a single Many women who have a straightforward birth on the room may be available if you prefer. Staff will support you Consultant Led Delivery Suite transfer here for their in feeding and caring for your baby. postnatal care. If you have a low risk pregnancy, you can have your Market Drayton and Whitchurch Midwives at these community hospitals offer antenatal baby at any of our MLUs, even if it is not the one nearest to where you live. Please phone the MLU and postnatal care and a homebirth service. Tel: 01630 650727 (Market Drayton) direct if you would like to go and see the unit. You can also come to any of our MLUs to have your Tel: 01948 660838 (Whitchurch) baby if you live outside Shropshire. Please note that in times of very high activity we may Home birth service For women with a straightforward pregnancy with no need to implement our escalation policy to ensure the safety of women and babies. complications anticipated during the birth, there is the option of having a homebirth. Midwives are on call for This can mean that you are not able to give birth in the you once you reach 37 weeks of pregnancy. A midwife unit of your choice, either because the unit is closed will support you at home during your labour and a altogether or because staff have had to be redeployed second midwife will join you for the birth of your baby. to cover other areas. You can have all forms of pain relief (including gas and air and pethidine) at home except for an epidural. You can If you are low risk, we can still offer you low risk care also buy or hire a water pool for a water birth at home. in our other units that remain open. It is likely that you will be able to transfer back to your unit of choice for Now read our leaflet: ‘Deciding where to have my baby’ so that postnatal care once the period of high activity is over. you can understand all the risks and benefits of the different At times when the escalation policy is implemented, options for place of birth and decide the best option for you. we may have to ask women planning a home birth to attend one of our units instead, so that staff can be redeployed for the safety of the service.
4 Pregnancy Information Our Consultant-led Unit The Consultant Led Unit includes the Antenatal Ward, The delivery suite has 13 en suite delivery rooms, one the Delivery Suite and the Postnatal Ward. of which has a birthing pool. There are two dedicated obstetric operating theatres with an adjacent recovery The Antenatal Ward area. Those with mobility problems can use the assisted This ward offers inpatient antenatal care to women with bath/shower room. medical and obstetric problems such as raised blood pressure or a low lying placenta. We regularly liaise with The postnatal ward other specialities within the hospital and consultant This ward cares for women requiring consultant led teams from the medical and surgical centres visit as postnatal care after normal and assisted deliveries. If your required. Induction of labour also takes place on this baby needs extra care after delivery, you will be looked ward. There are six en suite side rooms and two spacious after together under Transitional care (see page 9). four-bedded bays which each have a dedicated shower room and separate toilet. Please note that only one Most women only require consultant care for 24 - 48 birth partner can stay on the word outside visiting hours after the birth. You can then transfer to a midwife times when a woman needs support. led unit or home for the rest of your postnatal care. There is a TV monitor by each bed where patient The ward has 11 single en-suite rooms, three spacious information can be accessed, and a Pay TV system is four-bedded bays each with shower room and toilet. available. There is also a breast-milk kitchen, a room for baby care demonstrations, and other areas for staff. Women with The Delivery Suite mobility problems have an assisted bath/shower room. There is a TV monitor by each bed where patient information can be accessed, and a Pay TV system is available. Security is important on all wards and visitors are requested to identify themselves via an intercom before being allowed access. There is also an electronic baby tagging system. Please note that you will be able to stay on this ward for a few days if your baby is on the Neonatal Unit, but may have to leave when you are well if your bed is needed for women who have just given birth.
Additional facilities at the Consultant Led Unit There are two rooms on the Unit for those who have suffered a loss. These rooms have double beds, en suite bathrooms and a kitchenette. There is also a counselling
room where staff can speak to families affected. You can find a virtual tour of the Consultant Unit on our website at: http://www.sath.nhs.uk/wards-services/az-services/maternity/ Some women will be advised to give birth in the hospital Consultant Led Unit at the Shropshire Women and Children’s Centre in Telford. This may be due to previous complications during pregnancy or birth or due to a pre¬existing medical condition. You may be at higher risk of developing complications during birth. Our highly trained and experienced midwives will care for you with a team of obstetricians, anaesthetists and neonatologists if required. Pregnancy Information 5
Deciding where to have your baby
It is really important that you know about the different options for where you can have your baby, what is available at each option, which options are suitable for you and the risks and benefits of having a baby in your chosen option.
Please read the section: What we offer: Shropshire Having a baby at home Maternity Services which tells you where women can For women with a straightforward pregnancy with no give birth in Shropshire. complications anticipated during the birth, there is the option of having a homebirth. The right choice for you* Is homebirth safe? Giving birth is generally very safe for you and your baby. NO COMPLICATIONS (green) The ‘Birthplace in England Research Programme’ found that women having second or subsequent babies did Home not have any increase in poor outcomes for the baby compared to having their baby in a midwife-led unit or a Any midwife Led Unit consultant unit.
For women having their first babies, a small increased risk to the baby was found (9.3 per thousand births as MODERATE COMPLICATIONS compared to 5.3 per thousand), which means that 99.07% OR COMPLEX SOCIAL of first babies born at home have a normal outcome FACTORS (amber) compared to 99.47% in hospital. Consultant Led Delivery Suite Benefits of homebirth Same Site Midwife Led Unit • You are more likely to have a normal vaginal birth with less intervention. Any MLU/Home (depending on individual • You may fell more in control and better able to cope circumstances) in a place you know with your family around you. • You will be looked after by midwives in the comfort and relaxation of your own home. HIGHER LEVEL RISK (red) • You may feel you will have more freedom to do as you Consultant Led Delivery Suite wish rather than having to fit into a hospital routine.
• You may feel you will have more privacy.
This diagram shows the choice of place of birth in • If you have other young children, there is no need to Shropshire and the options for women depending on leave them to go into hospital. their suitability • You won’t have periods of separation from your If you are low risk right up to the time you give birth, you partner and family after birth. can give birth at home or in a Midwife-led Unit (MLU).
If you are higher risk, you will be advised to give birth You can have all forms of pain relief (including gas and either on the same site MLU or on the Consultant-led air and pethidine) at home except for an epidural. If you Unit. are considering a water birth at home please discuss this with your midwife or Midwifery Advocate and see our For some women it is safer to give birth on the leaflet,Water labour and birth. Consultant-led Unit. Risks of homebirth You can understand about how and why we assess risks • For women having their first babies, a small increased for individual women by reading our leaflet: Risks in risk to the baby was found (9.3 per thousand births pregnancy. as compared to 5.3 per thousand), which means that 99.07% of first babies born at home have a normal outcome compared to 99.47% in hospital.
6 Pregnancy Information • You may have to transfer to the Delivery Suite in the MLUs offer the increasingly popular option of having Telford should problems arise. The most common a water birth. reasons for transferring to hospital are where your labour does not progress as well as expected or if Benefits of an MLU birth there is concern about you and/ or the baby. Some Research has shown that women supported only by women may wish to go into hospital for an epidural midwives in labour: during labour. • Need less pain relief • If you need to transfer to the Delivery Suite in Telford an ambulance will be arranged for transport. • Are more likely to have a normal vaginal birth with less intervention The Birthplace in England study (2011) found that 45% of first time mothers were transferred from home to • Are more satisfied with their experience of birth hospital in labour, and 12% of women who had had a than women giving birth in Consultant-led units baby before. You are more likely to be transferred if you are having your first baby because first labours tend to • Are more able to be active during labour, which helps be longer. with coping with pain and can promote the progress of labour If you are considering a home birth, talk to your midwife who will be able to give you a leaflet: Why choose a home Disadvantages of an MLU birth birth? • You may have to transfer to the Consultant-led Delivery Suite in Telford should problems arise. The Please note that it is illegal for any person to deliver most common reasons for transferring are where a baby other than a registered midwife or medical your labour does not progress as well as expected practitioner, or student midwife or medical student who or if there is concern about you and/ or the baby. is being supervised by a midwife or doctor, unless in an Some women may wish to go the Delivery Suite for emergency. an epidural during labour. You are more likely to be transferred if you are having your first baby because Having a baby at a Midwife-led Unit first labours tend to be longer. (MLU) • If you need to transfer to hospital an ambulance will be arranged for transport. Research shows that women with straightforward pregnancies and no complications have no increased risk Transfers from freestanding units usually take place by if they decide to give birth at a Midwife-led Unit than if ambulance. From a recent audit, average transfer times, they choose to give birth in a Consultant-led Unit. This including time taken for the ambulance to arrive and for applies to first time mothers and to those who have had you to be secured and ready to travel, are: a baby before. • Bridgnorth 68 minutes Who cares for you on an MLU? • Ludlow 83 minutes The Midwife Led Units are run by experienced midwives • Oswestry 87 minutes who undertake regular updating, training and drills so • Shrewsbury 50 minutes that they are able to manage any emergency situation, • Wrekin 5 minutes by chair or bed however rare. They are available 24 hours a day and will be able to give you all the support you need during your All babies were born in good condition. All were vaginal pregnancy, labour and the early days with your baby. deliveries and the majority were due to delay in the first The midwives are supported by experienced Maternity or second stages of labour. Support Workers at the MLUs. Women who need to be transferred from Newtown or There are no doctors on site, but Midwives have 24 hour Welshpool in Powys have an approximate ambulance access to our Consultants and can discuss and refer transfer time of 80 minutes and 50 minutes, respectively, any problems that arise during pregnancy or labour. The plus time for arrival and making ready for transport. MLU at Telford is on the same site as the Consultant-led Delivery Suite. NICE guidelines advice maternity services to inform women that if something goes seriously wrong during your labour Facilities for birth (which is rare) it could be worse for you and your baby than if We encourage mobility during birth, and have birthing you were in a hospital with access to specialised care. balls and floor mats, as well as adjustable beds, to help you find the most comfortable positions at different stages in your labour. TENS, Entonox (gas and air) and pethidine (injection) are available for pain relief in all units, and all
Pregnancy Information 7 If you have a low risk pregnancy, you can have your baby Disadvantages of birth on the Delivery at any of our MLUs, even if it is not the one nearest Suite to where you live. Please phone the MLU direct if you Research has shown that would like to go and see the unit. You can also come to any of our MLUs to have your baby if you live outside • You may need more pain relief Shropshire. • You are less likely to feel in control Having a baby on the Consultant- • You are more likely to have interventions during the led Delivery Suite birth such as a drip and be continuously monitored Some women will be advised to give birth in the hospital • You are more likely to need an operative birth Consultant Led Unit at the Shropshire Women and Children’s Centre in Telford. This may be due to previous • You may be further from your home, depending on complications during pregnancy or birth or due to a pre- where you live. existing medical condition. You may be at higher risk of developing complications during birth. • You may be less satisfied with your experience of birth Our highly trained and experienced midwives will care for you with a team of obstetricians, anaesthetists and You may want to read: neonatologists if required. 1. http://www.npeu.ox.ac.uk/birthplace If you have any problems during labour, obstetric and This document gives you information about the best neonatal teams are available 24 hours a day on site. If place to have your baby based on best current evidence. you require regional (epidural or spinal) or general anaesthesia, anaesthetists are available on the delivery 2. NICE 2017 . lntrapartum care: care of healthy women suite, and will attend according to the urgency. There and their babies during childbirth. www.nice.org.uk are two operating theatres on the Delivery Suite used for planned and emergency caesarean sections, some Please note that in times of very high activity we may to assisted births (forceps and ventouse) and for other implement our escalation policy to ensure the safety of procedures such removal of a placenta if it does not women and babies. separate after the birth. This can mean that you are not able to give birth in the You can read more about operative and assisted births unit of your choice, either because the unit is closed in other leaflets: altogether or because staff have had to be redeployed to cover other areas. • Elective (planned) caesarean section If you are low risk, we can still offer you low risk care • Emergency caesarean section in our other units that remain open. It is likely that you will be able to transfer back to your unit of choice for • Operative vaginal birth (forceps and ventouse) postnatal care once the period of high activity is over. • Epidural anaesthesia
Advantages of birth on the Delivery Suite • Direct access to obstetricians, anaesthetists and neonatologists (special care baby doctors)
• The option of having an epidural for pain relief. An epidural is a special type of local anaesthetic given into your back which can numb the feelings of pain. It needs to be given on this unit as it involves an anaesthetist and means you have to be closely monitored during your labour.
• You will not need to transfer if there are problems during the labour.
8 Pregnancy Information
For more information visit www.networks.nhs.uk-nhs-networks-staffordshire-shropshire-and-black-country-newborn Pregnancy Information 9
• By 10 weeks you should attend your first antenatal appointment with a midwife often called your ‘booking’ visit. This can be in one of Shropshire’s Midwife Led Units, or a local Children’s Centre. • Get a Maternity Exemption Certificate (FW8) from your midwife or doctor. This entitles you to free prescriptions from confirmation of your pregnancy until a year after the baby is born.
• Healthy Start vouchers are available to pregnant women who are on certain benefits. All pregnant women under the age of 18 qualify for Healthy Start vouchers - whether or not they are on benefits. Vouchers can be exchanged for milk, fresh fruit and vegetables (www.healthystart.nhs.uk). • You will be offered blood tests to check your blood group, your iron levels and to check if you have any other infections which could affect the baby. If you are under 25 years old, your midwife will offer you Chlamydia screening. • Chromosomal abnormality Screening will be discussed and the choices available to you explained. • You will be offered a first trimester pregnancy scan from 11 weeks. Your partner may like to see this too and it may be possible to buy a photograph of the scan. • Chromosomal abnormality screening may be offered at the time of this scan (combined test). • If you’ve been feeling sick and tired in the early weeks, you will probably start to feel better around this time. • You will be offered a membrane sweep to try to pregnancy scan (Quad blood test). stimulate labour (from 40 weeks first baby; from 41 weeks otherwise). • You may be offered a date for induction of labour or additional monitoring if you choose not to be induced.
10 Pregnancy Information
WORKING IN PARTNERSHIP WITH YOU Are you having a straightforward pregnancy? Has your risk changed since your last appointment?
Have you asked: ‘Can I have my baby at a Midwife Led Unit?’ We do a risk assessment each time we see you. Your risk can be low, medium or high. Please discuss this with your midwife or doctor at every visit.
appropriate;
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During an antenatal assessment the health of you and your baby is checked by • Testing your urine • Testing your blood, with your consent, at your first • Measuring your blood pressure visit with the midwife and at 28 and 34 weeks. • Measuring your abdomen at every visit from 26-28 • Discussing any concerns you may have weeks to make sure your baby is growing well • Asking if your baby has been moving well (from • Listening to your baby’s heart beat from 20 weeks about 24 weeks) onwards
Triage and Day Assessment Units Often your local midwives can assess you initially if you have any concerns (contact numbers on back cover. Sometimes you will be referred to our Triage Service if you are experiencing any complications of pregnancy after 16 weeks, including reduced movements of your baby, vaginal bleeding or abdominal pain. You can ring the Triage Unit direct on 01952 565948. Your local Day Assessment Unit operates on an appointment system only for planned procedures such as glucose tolerance tests or fetal monitoring. Phone numbers for the Day Assessment Units are: Telford (adjacent to Wrekin MLU) 01952 565704 Shrewsbury (within Shrewsbury MLU) 01743 261216 At times when the Triage Unit is closed, you will be referred to the Consultant Led Unit at Telford (01952 565924).
12 Pregnancy Information
Pregnancy Information 13 Vitamin C helps the body to absorb iron, so to get
14 Pregnancy Information
. Under normal lifestyle and dietary conditions, the level of exposure of most women to individual environmental chemicals will probably pose minimal risk to the developing fetus/baby. However, women who are pregnant are exposed to hundreds of chemicals at a low level. On present evidence, it is impossible to assess the risk, if any, of such exposures. The following steps would however reduce overall chemical exposure:
It is unlikely that any of these exposures are truly harmful for most babies, but these steps will reduce environmental chemical exposures.
Female genital mutilation (FGM) FGM is the mutilation of the external female genitalia for non-medical reasons. It is a serious
criminal offence in the UK, with a maximum prison sentence of 14 years. It is still a crime if a UK national or UK resident carries out FGM abroad or assists or encourages someone to do it abroad. Anyone found guilty of failing to protect a girl from risk of FGM can receive up to 7 years in prison or a fine or both. NSPCC FGM Helpline 0800 028 3550
Childline 0800 1111 www.childline.org
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The Shropshire Recovery Partnership offers a range of services for people who have problems with drugs or alcohol. The team is based at Crown House, St Mary's Street, in Shrewsbury. If you are pregnant you will get a priority appointment with the team. You can phone 01743 294 700 or drop into the office between 09.00am and 5pm Tuesday-Thursday (not between 12.00 and 2pm).There are satellite offices in Bridgnorth, Ludlow, Oswestry, Wem and Whitchurch; phone the single point of contact number: 01743 294 700.
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Benzodiazepines (Valium)
Nicotine Replacement Therapy (NRT) Ideally, pregnant women should stop smoking without using Nicotine Replacement Therapy (NRT) but, if this is not possible, NRT may be recommended to help you stop smoking. The risk to the baby of continued smoking by the mother outweighs any potential adverse effects of NRT. NRT aims to replace the nicotine a smoker gets from cigarettes in other ways, for example through patches, gum, lozenges, tablets or inhalators. Electronic cigarettes are safer than smoking but other methods are recommended for pregnant women. E-cigarettes and their chargers must not be used inside our hospitals. NRT can double the chances of quitting smoking and combined with support, the chances of quitting are up to 4 times more likely to be successful. Always seek professional advice. Stop Smoking Services You can quit smoking with the benefit of expert support by accessing the free NHS Stop Smoking in Pregnancy Services. You can be seen in your own home, GP surgery, pharmacy or a community venue. You and your partner, family and friends can be fast tracked, meaning that you will be seen as quickly as possible. So if you are thinking about quitting, ask your midwife at any point through your pregnancy, or contact ‘Healthy Shropshire’ on 0345 6789025 or www.stop4life.co.uk The Stop Smoking in Pregnancy Services: • are non-judgemental
• will not tell you what to do • will listen
You can also find useful information on the dangers of smoking during pregnancy and tips for quitting at smokefree.nhs.uk.
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http://www.rospa.com/road-safety/advice/vehicles/ in-car-safety-and-crashworthiness/seat-belts/ for further information
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Pregnancy Information 19 • • • • • • • • •
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Safeguarding and social support If you need additional support during or after your pregnancy your Community Midwife will offer an ‘Early Help Assessment’ and signpost you to other agencies with your consent to meet your individual needs. If you have additional social needs you will follow the Antenatal Care Pathway for high risk women and the ‘Safeguarding and Supporting Women with Additional Needs’ (SSWwAN) pathway. Midwives caring for you and your baby work in partnership with other agencies to offer holistic support to you and your family. If your baby is thought to be at risk of significant harm, your midwife will make a referral to Children’s Social Services for additional support. Wherever possible she will
discuss her concerns with you.
20 Pregnancy Information
Pregnancy Information 21
22 Pregnancy Information
Group B streptococcus (GBS) This is a bacterium carried by about 30% of the population. In women it is found in the intestine and vagina, in most cases causing no problems. Occasionally, however, GBS can infect a baby just before or during labour, with serious consequences. National guidance does not recommend routine testing, but if you are found to be carrying GBS in your urine, or from a vaginal swab, you will be offered antibiotics in labour. When this is the case, you will be given a leaflet about preventing GBS infection in newborn babies. This leaflet can also be found on our website at: http://www.sath.nhs.uk/wards-services/az- services/maternity/. See also p. 59 for Group B Strep Support. Syphilis Hepatitis B Syphilis is a sexually transmitted infection. Most infected Hepatitis is a virus that affects the liver and can cause people do not have any obvious symptoms. If identified in pregnancy you would be referred for specialist care and immediate and/or long-term illness. It is transmitted may be treated with antibiotics. If it is untreated it can by exposure to infected blood or body fluids and result in serious health problems for the baby. pregnant women with hepatitis B will need specialist care in pregnancy. Vaccination will be offered for the baby in the first 24 hours after birth as this greatly reduces the risk of the baby developing hepatitis B.
Pregnancy Information 23 Other infections Mumps Women who develop mumps within the first 12-16 weeks Chickenpox of pregnancy may have a slightly higher risk of miscarriage Most women (95%) are immune to chickenpox from but there is no evidence that mumps causes defects in the having the disease, usually in childhood. If you have not had it, and you come into contact with someone who unborn child. The mumps vaccine is part of the MMR jab. has it, speak to your GP or midwife. You can have a blood test to check whether you are immune. Parvovirus This is also known as ‘slapped cheek virus’ because of the If you get chickenpox in your pregnancy it can be characteristic red rash it causes on the cheeks. It is a very dangerous for both your baby (particularly before 20 common infection, usually with mild symptoms, but it can weeks) and for you (around the time of the birth). If you sometimes be harmful to unborn babies if the mother come into contact with chickenpox, and you are not immune, you may be suitable for an immunoglobulin contracts the infection during the first half of pregnancy. injection that can make the infection shorter and milder. Sixty percent of pregnant women are immune to parvovirus because they have already had the disease, but if Cytomegalovirus (CMV) you come in to contact with someone who is infected, ask This virus can cause serious problems if a baby catches it your GP to check you are immune (this is done by a blood from its mother in pregnancy. It is important that pregnant women wash their hands after any contact with body fluids, test). If you are infected while pregnant you will be offered including after changing nappies, to prevent catching and additional ultrasound scans to monitor your baby. spreading the virus. Rubella (German measles) Measles Although this virus usually causes only minor illness in Measles is a highly infectious viral disease spread by childhood, if you catch rubella in the first four months of droplets, either by breathing them in or touching pregnancy, it can seriously affect your baby’s sight, hearing, contaminated surfaces. brain and heart. Measles can give rise to complications, sometimes serious, and these can be worse in pregnancy, affecting Ideally you should have had two doses of the MMR mother and baby. (measles, mumps, rubella) vaccine before pregnancy. You can check with your GP whether you have had this. If not, you If you come into contact with measles and have not had can have the vaccinations at your GP surgery after you have the disease or been vaccinated fully against it, please your baby. This will protect any future pregnancies. speak to your midwife or GP as soon as possible. Toxoplasmosis How the situation is managed will depend on a number of circumstances, according to national advice from This is caused by a parasite, and is rarely a problem in Public Health England. non pregnant people. Mild flu symptoms may be the only sign, but many people have no symptoms. In pregnancy MRSA (Methicillin-resistant Staphylococcus toxoplasmosis can have serious effects on your baby’s aureus) development, and can cause miscarriage and stillbirth. Up Staphylococcus aureus is a bacterium that lives harmlessly on the skin and in the nose of 30% of the UK population to 50% of pregnant women will be immune because they (this is called being colonised). Staphylococcus aureus can have already had the infection. Of those women who catch cause an infection if it enters the body, for example, the infection in pregnancy, the risk of infecting the baby is wound sites. Staphylococcus is usually treated with I 0-15% in the first trimester, 25% in the second trimester flucloxacillin but MRSA is resistant to flucloxacillin and and 70 - 80% in the third trimester. National guidance does some other antibiotics. not recommend routine testing in pregnancy, but suggests MRSA can be spread through the air and by contact that communicating the best ways to avoid infection is with other people. In order to reduce the risk of MRSA more effective. These are: being spread in hospital, pregnant women who are at higher risk of being colonised are offered a nasal swab at 36 • avoiding undercooked or raw meat weeks and offered treatment if necessary. You are at higher • avoiding cured meat, such as parma ham or salami risk if: • avoiding unpasteurised goats’ milk • avoiding contact with cat faeces or soil that is • You have had MRSA before contaminated with cat faeces • You have a serious medical condition For more information see • You are diabetic and have an open wound www.nhs.uk/conditons/Toxoplasmosis/pages/introduction • You’ve been admitted to a hospital ward (other than Maternity) in the last year Other infections from animals • You are a healthcare worker with patient contact or Ewes and lambs carry other bacteria which can cause if a household member or first degree relative is a miscarriage. Bird droppings can also harbour bacteria healthcare/care home worker harmful in pregnancy, so ask someone else to clean bird • You are having an elective caesarean section cages, or use disposable gloves.
There is some evidence that pigs carry hepatitis E. Avoid contact with pigs or pig faeces. Cook pork thoroughly.
24 Pregnancy Information flu vaccine, will cause any harm to pregnant women or their unborn baby. The vaccine offers immunisation for your baby up to 3 months of age. Your GP or midwife will be able to give you information on the current advice from the Department of Health regarding seasonal flu vaccination. Please contact your GP surgery to make an appointment for flu vaccination. If you think you may have flu, call your doctor for an assessment and advice. Zika virus Please visit www.nhs.uk/Conditions/zika-virus/Pages/ Introduction.aspx for information about Zika and links to get latest advice. Sepsis in pregnancy The term sepsis usually refers to a severe generalised infection such as septicaemia. In the past many women would become severely unwell or even die from sepsis in How the BCG vaccine works: childbirth. This is now much less common but still occurs. Recently Group A streptococcus has been a bacterium It offers considerable protection against tuberculosis. associated with an increase in the number of women with Although it may not always prevent a person from catching TB disease, it is very effective against the most severe forms of severe sepsis. the disease, such as TB meningitis in children. Group A streptococcus is the most common cause of sore Should your baby be identified for BCG vaccine, it is quite throats and chest infections in children. Group A strep can safe for them to receive this vaccine alongside the regular also be carried without the person having any symptoms. childhood immunisation programme. The bacteria are spread by direct person to person contact from infected secretions from the nose or throat or For further information visit infected wounds or sores on the skin. The bacteria can also www.nhs.uk/conditions/tuberculosis enter the body through a cut or scrape. Whooping cough It is therefore really important that you and your family Whooping cough is a highly contagious bacterial infection of avoid the spread of germs the lungs and airways. • Wash your hands thoroughly and often with soap and All pregnant women are now offered vaccination against warm water, especially after coughing and sneezing, whooping cough after 20 weeks of pregnancy. Getting before preparing foods, and before eating. vaccinated while you’re pregnant could help to protect your • Good perineal hygiene is also important -especially after baby from developing whooping cough in its first few weeks you’ve given bir th. Make sure you wash your hands of life. To protect your baby you need to get a vaccination in before and after going to the toilet and when changing every pregnancy. sanitary towels. You will be given a leaflet with more information about this in • See your GP as soon as possible if you or a close family the middle part of your pregnancy. member has a sore throat and fever. • Keep all wounds clean, and watch for possible signs of Seasonal flu and Swine (HIN I) flu In pregnancy, the immune system is naturally suppressed. infection such as rapidly increasing redness, swelling and This means that pregnant women are more likely to catch pain at the wound site. Anyone with signs of an infected flu and, if they do catch it, they are more likely to develop wound, especially if they develop a fever, should seek complications. medical advice as soon as possible. If you do develop complications these include cough, difficulty Your immunity is lowered when you are pregnant. breathing and dehydration due to the development of pneumonia (an infection of the lungs). In pregnant women, You need to seek medical advice if you have two or more this is more likely to happen in the middle and late part of of the symptoms below: pregnancy. • A rapid heart rate This can lead to severe ill health, premature labour, • A high or low temperature miscarriage, stillbirth or neonatal death. • Shortness of breath • Shaking and chills All pregnant women are advised to have seasonal flu • Abdominal or chest pain vaccination, whatever the stage of pregnancy. The seasonal flu jab currently offers protection against the HI NI virus, as well • Diarrhoea as other strains of flu virus. There is no evidence that inactive • Feeling generally unwell or feeling anxious vaccines, such as the seasonal and distressed
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Ultrasound scans use sound waves to build up a picture of your • baby in your uterus. To date, there is no evidence that ultrasound pregnancy. A fine needle is passed through a scans such as those used during pregnancy, do any harm to the baby or mother. In Shropshire, the Maternity Ultrasound Scan Department offers every pregnant woman a first trimester pregnancy scan between I I and 14 weeks and a mid pregnancy fetal anomaly scan between 18 weeks and 6 days and 20 weeks and 6 days. These scans are performed by midwife sonographers. Screening information Screening information, including screening tests for chromosomal abnormalities is contained in the ‘Screening tests for you and your baby’ leaflet which you will have been given by the time of your first antenatal appointment. It is important that you read and understand this information so that you can make an informed choice. Your midwife will discuss this with you. First trimester pregnancy scan This scan is to check the baby’s heartbeat, to see whether there is more than one baby, to measure the baby to estimate how many weeks pregnant you are, and to check for any major problems with the baby that are obvious at this early stage. Down’s syndrome screening Down’s syndrome is a learning disability that a baby is born with. Some health problems are more common in people with Down’s syndrome but it is impossible to know what level of learning disability a baby with Down’s syndrome may have. You may want to know in pregnancy whether your baby may be at risk of Down’s syndrome and there are screening tests that are offered to identify your baby’s risk and further tests to confirm a diagnosis. Depending on your gestation you may be offered: • A combined screening test between I I weeks and 2 days and 14 weeks and I day. This involves a blood sample from you and a • measurement of the fluid at the back of the baby’s neck (nuchal translucency) during the first trimester scan. The information is combined to work out the baby’s risk of having Down’s syndrome. It will also screen for Edwards’ syndrome and Patau’s syndrome. • A ‘Quad’ screening test which is offered between 14 weeks • and 2 days and 20 weeks of pregnancy. This is a blood test from which your baby’s risk of Down’s syndrome can be estimated. If either test identifies that your baby has an increased risk of a chromosomal abnormality you will be offered further tests to give a definite diagnosis: • CVS (chorionic villus sampling), which can be done between I • I and 13 weeks of pregnancy. A fine needle is passed through a woman’s abdomen and a tiny sample of placental tissue is removed and tested.
26 Pregnancy Information
If you have a multiple pregnancy, a very high BMI or a large fibroid these measurements will not be useful. Please discuss this with your midwife or doctor.
Pregnancy Information 27
If you need urgent help phone your nearest Midwife Led Unit, Obstetric Triage or the Delivery Suite (see back cover of your Pregnancy Health record)
28 Pregnancy Information
• Your urine gives vital clues about the health of you and your baby. • Your urine will be tested at every antenatal appointment. • Protein in your urine could indicate contamination from vaginal discharge or a urinary tract infection.
• Protein in your urine can be a sign of a pregnancy problem called pre-eclampsia and should be investigated. • Glucose in your urine could indicate the need for further investigation for diabetes. gestational diabetes. If this is found to be the case, you will have additional care from Specialist midwives and doctors (see Information leaflet; ‘Glucose tolerance test’).
Pregnancy Information 29 Your risk factors for having a DVT will be assessed at booking, if you have to be admitted to hospital and immediately after you’ve had your baby. If you are at high risk at booking, you will be given an appointment to see an obstetrician to discuss a plan of care with you. You may be advised to start treatment with injections of heparin (also known as Tinzaparin) which helps prevent blood clots forming. Your risk factors can change during your pregnancy and after the birth, e.g. if you become unwell or have a caesarean section. After you’ve had your baby you may be offered injections of heparin if your risk factors increase. For more information see our Leaflet: ‘Venous thrombosis in pregnancy and after birth’.
It is important that you are aware of your baby’s pattern of movements, especially after 26 weeks of pregnancy, as this is an indication of your baby’s health. If you are concerned that you haven’t felt as many movements or none at all, please contact your Day Assessment Unit or Midwife Led Unit straight
away. See the leaflet: ‘How active is your baby’ which you will be given at 24 - 28 weeks of pregnancy. Mental health problems during pregnancy and after giving birth Most women go through pregnancy and the first year after giving birth without any mental health issues, but some women do have problems. If you have any concerns about your mental health please talk to your midwife who can refer you to a specialist midwife for further support. There may be things you can do to help yourself. For example, if you are having problems sleeping, try to stick to a bedtime routine, and avoid caffeine and a lot of activity before going to bed.
30 Pregnancy Information In Pregnancy: heavily. Medication and surgical techniques will be • Women who already have a mental health problem used to limit the need for blood. During your booking are more likely to become ill again during pregnancy visit, you are asked whether you consent to a blood or in the first year after giving birth than at other transfusion, if necessary. Please be aware of the risks times in their life. and benefits discussed below. The reason for the blood transfusion should be explained to you. If blood is • Severe mental illnesses may develop much more given to you in an emergency, when it is not possible quickly and be more serious after giving birth than at to discuss the transfusion beforehand, the discussion other times. should take place when appropriate afterwards. • You are more likely to suffer mental health problems if you are not supported by family and friends, if your You can download the leaflets: ‘Will I need a blood pregnancy is unplanned, or if you have relationship transfusion’ and ‘Information for patients who have problems with your partner, including domestic received an unexpected blood transfusion’ from http:// violence. hospital.blood.co.uk/media/28307/160511-27360-will-i- • Sometimes women who have a mental health problem need-a-blood-transfusion-final.pd for from your midwife. stop taking their medication when they find out that they are pregnant without talking to their doctor or Having a blood transfusion midwife. This can make their illness return or become All blood donations in the UK are tested for viruses worse. such as hepatitis and HIV. Only blood that is free from these infections is used in a blood transfusion. The If this happens to you, you may need more urgent care chance of getting an infection from a blood transfusion and treatment than usual, because of the possible effects is very, very rare. Most transfusions during pregnancy on your baby, your own health and your other children. and after birth are given as red blood cells only. Very occasionally, platelets and plasma may be required as During pregnancy this help could include a referral to well. a Clinical Nurse Specialist who can help you develop a plan of how to access treatment should you become Once your blood type has been matched with the unwell and advise on treatment. There is also a mental donor type, the blood components are transfused health team at both RSH and PRH who can offer help if via a drip into your vein. You are carefully monitored you are an inpatient. before, during and after transfusion. Some people get mild side effects, such as headaches, chills and fever, a Psychological support rash and itchiness. These symptoms can be relieved by paracetamol and will improve within a day or so. Very Pregnancy and childbirth can be exciting and rewarding, rarely, there may be more severe side effects associated but can also be stressful or frightening. Some women with an allergic reaction, including difficulty in breathing, need extra support to deal with their anxieties, severe headaches and a sudden fall in blood pressure. relationships, and emotions. If you get these side effects, the transfusion will be stopped immediately and the situation reviewed. Your midwife will ask how you are feeling during your first (booking) appointment to see whether you For further information see: need any further support. A midwife will also visit you www.nhs.uk/Conditions/Bloodtransfusion/ between 24 and 28 weeks at home ask you questions to Pages/lntroduction.aspx see if you need any additional help and support at that and www.blood.co.uk time. Please contact your community midwife if you are If you want to refuse a blood transfusion You may feeling low at any time. decide you do not want to have a blood transfusion.
There are Psychological Wellbeing (IAPTS) can offer If you have any concerns or know you would decline individual or group support about low mood and the use of blood or blood components in any situation, anxiety. Please ring 01952 613822 for Telford or 0300 it is important that you discuss this with your midwife 123 6020 for Shropshire County to self refer. at the earliest opportunity. An appointment will be made to discuss your wishes and any concerns with a It is important that all professionals involved in your consultant obstetrician. You can also talk to the hospital care (e.g. midwife, GP or health visitor) are aware of any transfusion practitioner. mental health problems so that you can get support and advice when necessary. Otherwise it will be confidential. Alternatives to blood transfusion will be discussed, such as the use of cell salvage during a caesarean section. You Blood transfusion must be aware, however, that in some circumstances only a blood transfusion will save your life. A blood transfusion involves the transfer of blood or blood components from one person to another person. A management plan will be made with a consultant It is often done to replace blood that has been lost obstetrician for your pregnancy, labour and birth. You due to severe bleeding and can be life-saving. A blood will be asked to complete an advanced directive if you transfusion may be necessary in a non-emergency have not already done so. Your wishes will be respected. situation such as severe anaemia during pregnancy. In emergency situations such as during birth or afterwards, If at any point you change your mind, we will ensure this you may need a blood transfusion if you bleed very is documented in your casenotes, and ensure that your latest decision is respected.
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During pregnancy, your baby’s brain is growing very quickly and you can help this growth by taking some time out to relax and talk to him or her, to stroke your bump and maybe play some music. Encourage other close family members to do the same. There is a leaflet called ‘Building a happy baby’ which can be downloaded from: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/leaflets-and-posters/building-a-happy-baby/
women are encouraged to breastfeed or give as much breast milk as they can or as they feel able. Breastfed babies cannot be overfed so you can use breastfeeding to soothe your baby and as a way of spending time together, or having a rest whenever you both want. Responding to your baby’s needs for food and comfort will help him or her feel secure, so (s) he will cry less, which helps make your life easier too.
If you would like to attend our informal Breastfeeding support groups or workshops, please see the information at the back of this folder or ask your midwife. At Shrewsbury and Telford NHS Trust we have several midwives who are also Lactation Consultants who can help if you have more complex feeding problems. We have achieved Stage 2 UNICEF Breastfeeding Initiative Accreditation and are working towards Stage 3. When choosing a formula milk make sure you use a first or newborn milk. One brand is no better than another. Some manufacturers now supplement infant formula with additives that they claim have health benefits for babies. At present it is unclear if this practice is beneficial to babies (see www.firststepsnutrition.org/; https://www.unicef.org. uk/babyfriendly/baby-friendly-resources/leaflets-and-posters/ guide-infant-formula-parents-bottle-feeding/ Because formula fed babies do not receive the naturally occurring anti-infective properties of breast milk it is important that you are aware of the need for good hygiene when preparing formula feeds. Your midwife will be able to advise you about this. However you choose to feed your baby, a midwife will be available to help and support you at all times during your care. As you grow more familiar with your chosen feeding method you will gain confidence and learn to relax and enjoy seeing your baby thrive and grow.
This Trust believes that breastfeeding is the healthiest
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Pregnancy Information 33
or left until you go into labour naturally? See p.37 for
For advice on preparing your dog for the arrival of your baby, see https://www.dogstrust.org.uk/help-advice/factsheets-downloads/factsheetnewbabynov13.pdf
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Perineal massage: Research has shown that massaging your perineum from about 34 weeks of pregnancy reduces
the change of a tear or bruising to this area during birth. this is particularly beneficial if you are having your first baby. For more information about perineal massage, see: https:// www.nct.org.uk/pregnancy/perineal-massage • How do I feel about an assisted delivery or an emergency caesarean? Sometimes you may need some help to give birth to your baby. Read the section on ‘Assisted births’ for more information (p. 47). • How do you feel about feeding and nurturing your baby? See p. 32 to help you think about this. If you think you may want to feed your baby with formula • Would I like my baby to have vitamin K? Vitamin K helps milk, please bring pre-prepared milk for newborn babies, to prevent a serious blood clotting disorder and it can be preferably in ‘Starter pack’ form - available from many given either by injection or orally (drops in the mouth) - supermarkets. There is no need to bring milk if you want see p. 53. to breastfeed as we can supply formula if supplementary feeds are needed. Finally, remember to be flexible, especially if this is your first baby. What might appeal to you now might not be what you actually want when in you’re in labour: Write out your birth preferences on the form provided in your Pregnancy Health Record. http://www.sath.nhs.uk/wards-services/az-services/maternity/classes-workshops/ Patient: http://patient.info
Accredited Online Antenatal and Postnatal classes are available at: www.inourplace.co.uk. These classes are free at least until March 2017. A Virtual Tour of the Consultant Led Services at the Shropshire Women and Children’s Centre is available on our website. www.sath.nhs.uk. Pregnancy Information 35
Please see information on page 8 about
what may happen at times when the service is extremely busy.
36 Pregnancy Information Induction of labour having a sweep means that you are more likely to go Induction of labour can take many hours or even days. into labour naturally. Women having their first baby are Transfer to the Delivery Suite can be delayed for offered a sweep at 40 weeks and again at 41 weeks if they women not in established labour if the unit is very busy. have not gone into labour. Women who have had a baby before will be offered a sweep at 41 weeks. Induction of labour is a process designed to start labour artificially. You may be offered induction if you or your What are the benefits? baby’s wellbeing is causing concern or if your pregnancy is nearing 42 weeks. Discuss the options with your doctor • It reduces the need for other methods of induction or midwife and ensure you understand the procedure of labour as you are more likely to go into labour and the risks and benefits. naturally. • It does not involve drugs and can be repeated Why is induction of labour offered? • You do not need to come into hospital to have it done There are a number of reasons why induction of labour may be suggested: What are the disadvantages?
• Prolonged pregnancy after 42 weeks. Women with • It can be uncomfortable straightforward pregnancies will be offered induction • Sometimes you may get some light spotting of blood of labour between 40 weeks + 12 days and 40 weeks + 14 days. This follows the National Institute for Clinical Prostaglandin, pessary, gel or tablets Excellence (NICE 2008) guidance on induction of You will usually be offered prostaglandins (also known labour.The risk of stillbirth increases from I in 1000 at as Propess or Prostin) to help start your labour. 41 completed weeks to 2 in I000 after 43 completed Prostaglandins act like natural hormones and help soften weeks. the cervix gradually just as in natural labour. • Maternal age over 40. Women who are 40 or older at their booking appointment will be offered induction of The prostaglandin medication is inserted into the labour at 40 weeks. vagina during a vaginal examination. The programme of medication given will depend on individual circumstances. • Your waters have broken before labour starts. This More than one does is often required, and once the is known as prelabour rupture of the membranes maximum dose has been given, your plan of care will be (PROM).When this happens labour usually starts within reviewed by an obstetrician. 24 hours. However, the risk of infection increases the longer the time between the waters breaking and the You will need to lie down for 30 minutes after the birth of your baby. medication is given, during which time your baby’s heart • If you or your baby’s wellbeing is giving cause for beat will be listened to again. After this you will be concern, for example, if you have high blood pressure encouraged to get up and move around as this will help or the baby is not growing properly. labour to progress. Period type pains are common and you will be offered pain relief and warm baths. You can Induction does not increase the likelihood that you will also use a TENS machine (see p.43). need a caesarean section in labour. What are the benefits? What if I prefer to wait until I go into labour naturally? • Prostaglandin can encourage the cervix to soften and You may prefer not to be induced and to wait until you open. You might go into labour as a result, or your go into labour naturally. If you decline induction, you cervix might open enough to allow your waters to be will be referred to a consultant obstetrician and offered broken, which can also help to start your labour. increased monitoring, including listening to the baby’s heart beat and ultrasound scans. A plan will be put in What are the disadvantages? place for your baby following delivery, as there is a risk of complications from reduced energy reserves. • Sometimes more than I dose is needed. • Some women experience strong contractions often How is labour induced? called ‘Prostin pains’ but the cervix does not change It is usual to offer a membrane sweep first to help you go very much. Further doses of gel may be needed and into labour by yourself. This is performed during a vaginal often women can become tired from this long process examination and can be done at home, in a Midwife Led of induction. Unit, GP surgery, Day Assessment Unit or Antenatal • Side effects can include nausea, vomiting, diarrhoea and Clinic. If the membrane sweep does not start labour vaginal soreness. other methods can then be used depending on their • Very occasionally prostaglandins can make your uterus suitability and what is happening to your cervix (neck of contract too much and you may need other medication the womb): to counteract this. Excessive uterine contractions can • Prostaglandin, pessary, gel or tablets result in a significant complication such as uterine • Artificial rupture of the membranes rupture (a tear in the uterus) or placental abruption • Oxytocin drip (where the placenta partially or completely separates from the uterus); however, these complications are Membrane sweep rare. If you have had a previous caesarean section or During a vaginal examination, the midwife or obstetrician any other surgery to your uterus, your obstetrician will places a finger into your cervix and, with a gentle sweeping discuss and agree a management plan with you. movement, separates the membranes which surround the baby from the cervix. It can be uncomfortable but
Pregnancy Information 37 Some women go into labour after administration of • Your ability to move around during labour will be prostaglandin. If your cervix has softened after the reduced; however, you can still sit in a rocking chair, prostaglandin has been given, but you haven’t gone into use a birthing ball or stand. labour, the next step is to break your waters - also known • The contractions may be more painful than natural as artificial rupture of membranes (ARM). contractions and some women may find they need extra pain relief. If there are any reasons why you should not have prostaglandin, your induction process might be started If oxytocin has been used during labour, it’s by having your waters broken. recommended that you have an active third stage to deliver your placenta. This means that the midwife will Artificial rupture of the membranes give you an injection immediately after the birth to help You will need to be transferred to the Delivery Suite your uterus to contract to deliver the placenta and for ARM. This may be delayed if the Delivery Suite is control any bleeding. very busy with other women waiting for an ARM ahead of you and women arriving in active labour. This can feel Coming into hospital for induction frustrating for you, especially when staff may not be able Your midwife or obstetrician will arrange a date and to give you precise timings for your transfer. time for you to be admitted onto the Antenatal Ward at the Shropshire Women and Children’s Centre in Please bear with us; as long as you are not in labour, and Telford. Please bring your Pregnancy Health Records, you and your baby are not at high risk, it is safer for you any prescribed medication and your labour bags. You will to wait until the Delivery Suite is not too busy. be welcomed by the ward staff and shown around the ward. An ARM is done during a vaginal examination using a plastic hook to make a hole in the amniotic sac. Please remember that the time it takes to This, and the baby’s head being in contact with the get into labour can vary from a short time cervix, stimulates the release of natural prostaglandins to many hours or even days. If labour ward is (hormones that start labour). The vaginal examination exceptionally busy, then it may not be safe to can be uncomfortable, but the actual breaking of the start your labour. Your induction may be delayed membranes does not hurt. Ask to use some entonox but you and your partner will be kept informed (gas and air) if you are worried about the discomfort. by the midwifery staff. After your waters have been broken you will need to When you come into hospital you will have your blood have your baby’s heart rate monitored for about 30 pressure, pulse, and urine checked. Your baby’s heart minutes. You will then be encouraged to get up and walk beat will be monitored and then with your consent the around to help start your labour. If you have not gone midwife will do a full check of you and your baby. With into labour 2 hours after your waters have been broken, your consent she will do a vaginal examination to assess then you will be advised to have an oxytocin drip (see the readiness of your cervix for labour. A plan of care section below). The oxytocin drip can be started earlier, can then be made as to how best to help start your depending on the reason for your induction of labour. labour.
What are the benefits? Can my birth partner stay with me? • Having your waters broken can be enough to start You partner is very welcome to stay during visiting your labour hours (see p. 8). • No drugs are involved We are trying to accommodate as many birth partners What are the disadvantages? as possible overnight when a woman is being induced. • Once your waters have been broken, the procedure We have only 6 side rooms, so this is not always to get you into labour cannot be stopped due the risk possible. Please note that we can only accommodate of infection. one birth partner to stay overnight. • There is a small chance that the baby’s umbilical cord may slip past the baby’s head (a cord prolapse). Cord All women who are transferred to the Delivery Suite prolapse is not common, occurring in about I in 200 can have up to two birthing partners with them all births. the time. The ward staff will be happy to contact your partner for you. Oxytocin drip Syntocinon is a synthetic form of the natural hormone Pain relief oxytocin and encourages contractions. You will need to Pain relief is available for you on the Antenatal Ward. be on the Delivery Suite. Syntocinon is given through If the prescribed medication is not helping sufficiently, a drip in your arm or back of your hand. The drip is please ask your midwife to arrange for more pain relief. increased very slowly until you are having strong and regular contractions. What happens if induction is not successful? Occasionally, despite trying all the methods of What are the benefits? induction, labour does not begin. If this is the case, your • Encourages contractions to help start your labour obstetrician will make an individual plan with you for the birth of your baby. What are the disadvantages? • Your contractions and your baby’s heart rate will need to be monitored continuously as some babies can become distressed by the contractions. The References midwife will adjust the rate of the drip if you start I. NICE 2008: CG 70 Induction of labour www.nice.org.uk contracting too much. Sometimes the drip has to be stopped.
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Please be sure to read the section on the ‘Latent phase of labour’ (p. 36) There are three stages to labour. In the first stage the cervix gradually dilates (opens up). In the second stage
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40 Pregnancy Information easier. Research has also shown that there is less chance 2 of needing an assisted delivery . If you feel tired you can always lie on your side. Pushing You will usually feel a strong urge to push with the contractions and the baby will gradually descend with your pushing efforts. Women can have the feeling that they want to open their bowels and this is quite normal. Sometimes a woman might not have the urge to push and it is best to wait until her body is ready. Your midwife will give you lots of help and support. When the baby is about to be born, the midwife will tell you to stop pushing, to push very gently, or pant to stop yourself pushing. This is so that your baby’s head can be born slowly, giving the skin and muscles of the perineum (the area between your vagina and back passage) time to stretch without tearing. Please the information on p. 35 about perineal massage to prepare your perineum for labour. Sometimes the skin of the perineum won’t stretch enough and may tear. There may be a need to deliver the baby quickly and with your consent the midwife or doctor will give you a local anaesthetic and make a surgical cut from your vagina at an angle into your perineum. This is called an episiotomy and is done to make the vaginal opening bigger. Afterwards the cut or tear will be stitched and start to heal. Small tears or grazes are sometimes left to heal without stitches because they often heal better this way. Once the head is born, most of the hard work is done and you will be asked to give one more gentle push to deliver the baby. The baby will be dried and lifted onto your tummy so that you can hold the baby and be close to each other immediately. This is called skin to skin contact. You and the baby will be covered with a towel or blanket to keep you both warm. Usually the baby is very keen to breastfeed at this time and your midwife can help you if you wish. 1 Third stage After your baby is born, more contractions will push out the placenta. This usually takes between 5 minutes and 60 minutes depending on how you choose to deliver the placenta. You should be offered a choice of: An active third stage A drug called Syntometrine or Syntocinon is given by injection into your leg to help the uterus contract. The contractions will help to separate the placenta from the walls of the uterus. The midwife will clamp and cut the baby’s umbilical cord and gently pull the cord to help deliver the placenta.
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(see page 31).
References: I. NICE 2017: CG190 lntrapartum care: care of healthy women and their babies during childbirth. www.nice.org.uk 2. Royal College of Midwives (2012) Evidence Based Guidelines for Midwifery-Led Care in Labour.
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heated birthing pools which recirculate water with a pump for home births, after such pools have tested positive for Legionella bacteria.
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44 Pregnancy Information
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46 Pregnancy Information
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A few women may be upset their experience of birth. Speak with your obstetrician or midwife, if you feel worried about this. You can ask to attend our ‘Talkabout’ Service if you feel you would like to discuss your labour and birth. Ask your midwife about this or see your ‘After the birth’ booklet.
The obstetrician will take into account the wellbeing of you and your baby and discuss the options for your situation with you. Approximately 10% of women delivering in Shropshire in 2015/16 had an assisted birth using ventouse or forceps2. Women who have assisted births have a less than I0% chance of needing ventouse or forceps with their next birth.
RCOG (2011) Operative Vaginal Delivery. Greentop Guideline 26. Royal College of Obstetricians and Gynaecologists, London.
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Caesarean section is major surgery where the baby is born through a cut in the mother’s abdomen and uterus. There are two kinds of caesarean section - an elective or planned caesarean, where the decision is taken before labour begins, and an emergency caesarean section. The decision to have an emergency caesarean section usually takes place when you are already in labour and there is an unexpected problem. Caesarean sections take place in dedicated maternity theatres on the Delivery Suite at the Shropshire Women and Children’s Centre. During 2015/ 16 the caesarean section rate in Shropshire (both planned and emergency) was 19.4%.This compares with the caesarean section rate for England (2014) of 26.2%. In Shropshire in 2015/ 16, 7.8% of births were planned caesarean sections, and I 1.9% were emergencies. Only 3% of births were classed as ‘Category I’ emergencies, which means that there is a possible immediate risk to the mother or baby.
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50 Pregnancy Information chest area downwards. See page 44 for more information about regional anaesthesia.
The following risks are estimates3. For help in considering risks please see the table on p. 46.
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52 Pregnancy Information
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54 Pregnancy Information
New father are entitled to up totwo weeks pay. You may also be entitled to up to 26 further weeks of paternity leave, 20 of which will be paid if transferred from the mother.
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56 Pregnancy Information Sharing information To ensure that the best possible care and advice can be given to you and your baby, information may be shared with other organisations. These may include services for
smoking cessation or weight management, health visitors or for screening purposes. You can opt out of these services if you wish. You may also be receiving care from organisations outside the NHS, such as social services. If so, we may need to share some information about you so that everyone involved in your care can work together for the benefit of you and your baby. Only relevant information about you that is genuinely needed will be passed on. In limited circumstances we have a legal duty to provide information about people without seeking their consent. When we do this we will only provide the minimum of information needed and will inform you whenever possible. Examples of this are: notification of a birth; reporting some infectious diseases; protecting children or vulnerable adults who are unable to decide whether their information should be shared.
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58 Pregnancy Information ACAS (Advisory, Conciliation and Arbitration Service) Count the Kicks 03000300 123123 11001100 Helping women to be aware of their baby’s movements www.acas.org.uk to ensure the healthy delivery of their babies: Offering advice on time off for antenatal care and on www.countthekicks.org.uk/ maternity rights, parental leave and matters like unfair CRY-SIS dismissal. 0845 I 228 669 Active Birth Centre www.cry-sis.org.uk 0207 281 6760 Offers support for families with excessively crying, www.activebirthcentre.com sleepless and demanding babies. Promotes a holistic approach to active childbirth and Disability pregnancy and parenting international parenting. [email protected] Alder Hey Children’s Hospital www.dppi.org.uk www.alderhey.nhs.uk For disabled people who are already parents and their 0I5I 228 481I families, those who wish to become parents and also Antenatal Results and Choices (ARC) for health and social work professionals concerned with disability and/or pregnancy and parenting. Helping parents and healthcare professionals through antenatal screening and its consequences Down’s Syndrome Association www.arc-uk.org 0333 121 2300 0845 077 2290 (helpline) www.downs-syndrome.org.uk APEC (Action on Pre-eclampsia) Drink Aware 0208 427 4217 (helpline) 0300 123 I I I O (Drinkline) www.action-on-pre-eclampsia.org.uk www.drinkaware.co.uk National charity offering support and information about Easyhealth pre-eclampsia via its helpline and newsletters. Also Information for those with learning difficulties, using provides a befriender service. easy words with pictures. Association for postnatal illness (APNI) www.easyhealth.org.uk 0207 386 0868 Epilepsy Action www.apni.org 0808 800 5050 (helpline) Network of telephone and postal volunteers who have www.epilepsy.org.uk suffered from postnatal illness and offer information, Group B Strep Support support and encouragement on a one-to-one basis. gbss.org.uk Best Beginnings Baby Buddy App 01444 416 176 Baby Buddy is an interactive app developed by Best Healthwatch Beginnings to support you during pregnancy and as a new parent. Find it at: www.bestbeginnings.org.uk/baby- An independent Charity working to make local health buddy and social care services better. Birmingham Children’s Hospital Shropshire 01743 237884 www.healthwatchshropshire.co.uk/ www.bch.nhs.uk 0121 333 9999 Telford 01952 739540 www.healthwatchtelfordandwrekin.org.uk Birth Trauma Association Healthy Start www.birthtraumaassociation.org.uk www.healthystart.nhs.uk Care of the next infant scheme (CONI) 0345 607 6823 (helpline) 0808 802 6868 (bereavement support) or Free vouchers for milk, fruit, vegetables and vitamins for 0800 802 6869 (information and advice) those on low incomes www.lullabytrust.org.uk/coni Home-Start Co-ordinated help and support for parents who have 01743 241443 (Shropshire) suffered a cot death or infant death who was discharged home from maternity aged from 7 days to I year. www.homestartshropshire.org.uk Child Poverty Action Group 01952 243991 (Telford and Wrekin) www.homestarttelfordandwrekin.co.uk 0207 837 7979 www.cpag.org.uk Home-Start helps families with young children as they learn to cope, improve their confidence and build better Campaigns on behalf of low income families. Information lives for their children. and advice for parents on benefits, housing and welfare rights etc CLAPA (Cleft Lip and Palate Association) 0207 833 4883 www.clapa.com Support for families of babies born with cleft lip and/or palate. Feeding equipment available.
Pregnancy Information 59 0300 123 1100
______Pregnancy Sickness Support www.pregnancysicknesssupport.org.uk
Date of publication: April 2017 Date of review: October 2017 60 Pregnancy Information